I think I deeply regret entering a Counseling Psychology Program

[The Block Block]

Advertisement - Members don't see this ad

Hi all

I'm an advanced student in a Counseling Psychology program in the south (not specifying more for anonymity purposes), and yeah, I have some pretty serious issues with Counseling Psychology and have been doubting my training. I will also be the first to admit that this may just be my program and is not indicative of the field as a whole.

Anyways, my core issue throughout my training has been the extreme emphasis on common factors based training with my exposure to assessment and EBPs pretty lackluster compared to my clinical colleagues. I really do feel as though it can, at times, feel like non-directive supportive therapy is what faculty/supervisors were looking for or prioritizing in what they wanted to see in us clinically. I feel like a total black sheep in my program and can't but help wonder if I should have stuck to solely applying to clinical PhDs or if this is more of a program issue? I'm wondering if anyone else has ever felt this way and know that this can be a touchy subject?

 

[RxPsych]

Your experience in counseling psych is similar to what I observed in my counseling psych peers. Is there any way to seek experience in EBPs within the clinical department at your university? Maybe see if you can get a clinical supervisor for a semester in your internal clinic? At worst, maybe you have access to videos and/or clinician manuals for some EBPs you are interested in.

Another option is external practicum. Many of my counseling psych peers that were not satisfied with their mostly supportive therapy training sought external practicum at VAs and AMCs where they more than made up for the lack of EBPs in the internal clinic.

I would say try not to get discouraged at this point. Early in training, we are often limited in the types of therapy we experience via our internal clinics. Once you go on external practicum, internship, etc. you get much more experience in other therapeutic protocols if you are interested.

Edit: you mentioned you are an advanced student. Are you applying to internship soon? This would be a good opportunity to apply to sites that emphasize EBPs, and you can highlight your desire to gain experience in EBPs in your cover letters.

 

[The Block Block]

Your experience in counseling psych is similar to what I observed in my counseling psych peers. Is there any way to seek experience in EBPs within the clinical department at your university? Maybe see if you can get a clinical supervisor for a semester in your internal clinic? At worst, maybe you have access to videos and/or clinician manuals for some EBPs you are interested in.

Another option is external practicum. Many of my counseling psych peers that were not satisfied with their mostly supportive therapy training sought external practicum at VAs and AMCs where they more than made up for the lack of EBPs in the internal clinic.

I would say try not to get discouraged at this point. Early in training, we are often limited in the types of therapy we experience via our internal clinics. Once you go on external practicum, internship, etc. you get much more experience in other therapeutic protocols if you are interested.

Edit: you mentioned you are an advanced student. Are you applying to internship soon? This would be a good opportunity to apply to sites that emphasize EBPs, and you can highlight your desire to gain experience in EBPs in your cover letters.

This is a great idea and something I will try and seek out!

And yes, while I appreciate the attention to multicultural research that many counseling programs have really carved out, I still will be seeking out a site such as a VA or AMC where EBPs are the standard of treatment. Thanks for the perspective too, talking to clinical PhD students really helps give a grounded perspective as counseling psych can be quite insular.

 

[ccpsych16]

I went to a counseling psych program. Our professors drilled into us that a PhD is a research degree, and that was their focus. We learned basic therapy skills in introductory classes, but the bulk of our training in that area came from external practica. If you’re not getting the required experience, then there is either a lack of clinical training environments in your area, or your program does not partner with enough training sites. I would not lay this solely on the fact that your program is counseling. We had rigorous assessment and psychometric: experience in classes (2 semester assessment, 1 semester psychometrics) and practica. Many of my core classes featured both counseling and clinical students, and actually the clinical students made comments often that they wish they had more of OUR training. I trained in residential SUD, neuropsych, university counseling, VA, etc. My program allowed students to create their own practical by reaching out to local practices or organizations. See if your program will let you do that, which would give more options for all future students.

 

[cara susanna]

My school had a Counseling and Clinical PhD and our perception, as Clinical PhD students, was definitely that the Counseling program was less rigorous.

 

[Shiori]

If it helps, a lot of grad school is self-study. It's great when the classroom work makes it easier to get more seasoned perspectives, but I spent A LOT of time reading on my own. Your early training can help lay a solid foundation, but you will be driving your training for the majority of your career.

To echo the other comments, the good stuff happens in prac. Also, I know a few clinical people who might have benefitted from spending a little more time focusing on common factors.

 

[smalltownpsych]

The desire to learn more and fear that you are not being taught enough relative to others is a good sign in my mind. I am quite a few years out from education and training and continue to learn more and feel inadequate at times. For example, I am not even clear as to what focusing on common factors means. If it is referencing client centered techniques such as reflective listening in, fostering an empathic relationship, and good interview skills, then I would say that you might be getting good training as some of that is foundational. Trying to implement a treatment of any kind or even an assessment without developing rapport is not going to be effective. I train new clinicians all the time and where they need the most help and practice is how to communicate with people in distress or in need of our services. That being said, one way to fill the gaps from the school is by selecting training sites and internship and then postdoc that are strong in those other areas.

 

[Sanman]

Regret is a funny thing and you may have a different perspective down the line. Going to your program has two distinct goals:

1. Learning the foundations to be a good counseling psychologist.

2. Checking boxes to become a licensed professional and earn money.


You are in the program primarily for number 2 because it is the only way to accomplish that goal. Number 1 can be remedied at any point in your career. I, and several others here, have real world careers that are very different from what we trained for in grad school. Internship, post-doc, and beyond can help to fill in those gaps. Learning is a lifelong pursuit. School is just there to provide you with a piece of paper. Be more active in finding the opportunities that you want and check the boxes for the mandatory stuff.

 

[silverway]

If it makes you feel any better, I felt like my Clinical PhD taught me research and EBPs with less of a focus on the therapeutic process, common factors, etc. than I actually wanted. I remember walking out of classes thinking, "Okay I get the etiology and the cognitive distortions and the theoretical understanding of this disorder, but how do I actually handle it in the room?" I think many people wish their grad program was at least a little different. You're there long enough to see all the cracks up close.

Like everyone here is emphasizing, the nice thing is that you get to fill in the gaps and chart new waters with practica, internship, and even fellowship. I had zero health psychology experience until I entered my 5th year practicum, and after that practicum, I went on to a health psych internship and fellowship and it's where I work now because I discovered I really like it. I had a couple of supervisors with psychodynamic backgrounds that enriched my skillset beyond just standard CBT.

It might be frustrating to sit through however much of grad school you have left while getting training that feels subpar, but just don't be discouraged that this is all you're going to get, because it's not.

 

[ClinicalABA]

Our professors drilled into us that a PhD is a research degree

This is a bit of a misconception. A good Ph.D. program will require learning about and conducting research, but also involves equivalent or even more hours of clinical training and experience (per APPIC data) when compared with other degrees (Psyd) or training models (Counseling or Ed. Psych). Though most research positions are held by Ph.D.s, most Clinical Ph.D. grads go into clinical work vs. pure research positions.

The desire to learn more and fear that you are not being taught enough relative to others is a good sign in my mind. I am quite a few years out from education and training and continue to learn more and feel inadequate at times

This. Healthy doubting of one's own abilities and knowledge is a VERY good practice. At the time of your graduation, a lot of what you learned in your first few years (especially if it involved anything in a textbook), is either outdated or has been greatly expanded on with new research. For ancients like me, a lot what I learned in grad school is obsolete. That said, I did learn not to rely on what the professors taught me and how to continue my clinical learning on my own.

For example, I am not even clear as to what focusing on common factors means.

Glad I'm not the only one!

2. Checking boxes to become a licensed professional and earn money.

This is a BIG part of grad school, and why it's important to make sure your grad program meets at least minimum standards (e.g., APA accreditation) to do so. I'm currently in the process of getting another psych license, and I am SO psyched (pun intended) that I get to check the boxes that all my training was in APA accredited programs.

I, and several others here, have real world careers that are very different from what we trained for in grad school.

Yep- there is a difference of ~75 years in the age between the subjects of my dissertation and the clinical population I work with now. There's not a single test that I regularly administer now that I received training on in graduate school. The one that I use and rely on the most (the ADOS-2) was not even commercially available until after I graduated- I learned how to administer that one in a week spend in a hotel conference room a decade or so after I graduated. Incidentally, I first used the ADOS working side-by-side with another psychologist who was at my school the same time as I was, but I was in clinical and she was in Ed. Ph.D. programs.

As an advanced student, do your best to tailor your educational experiences (practicum and internship) to prepare you with a foundation for what you want to do. Further that focused training with a good post doc. After that, tailor your work experiences so that you get more specific training in areas of professional interest.

 

[ccpsych16]

This is a bit of a misconception. A good Ph.D. program will require learning about and conducting research, but also involves equivalent or even more hours of clinical training and experience (per APPIC data) when compared with other degrees (Psyd) or training models (Counseling or Ed. Psych). Though most research positions are held by Ph.D.s, most Clinical Ph.D. grads go into clinical work vs. pure research positions.

Absolutely, I didn’t fully agree with them but I understood their rationale. Often as students we would complain that, while that’s a nice idea in theory, most of us go on to clinical work, so they needed to do more on that end. But our professors weren’t budging. It also seems like some Gwen ton to professorship because of a strong dislike or disregard of clinical work, which influenced that too. We weren’t even a clinical science program.

 

[PsyDr]

1) I would HIGHLY recommend defining what you want to do in your day to day career. While supportive therapy is BS, the outpatient market has some demand for this practice (e.g., it's lucrative to endlessly treat the worried well). But if you want to work in an AMC or VA, EBP is much more desirable.
2) Saying, "I think I might deeply regret...." sounds like counseling. Saying, "I deeply regret..." sounds more like clinical.
3) If your university has a clinical program, or medical program, ask if you can audit some of their courses.

 

[EnPsychlopedia]

I am in a clinical program, not counseling, but my anecdotal experience with counseling psychology students has been a mixed bag between strong dedication to EBP and knowledge about the limitations of common factors research and the wholesale adoption of the belief that literally everything is common factors. I personally feel it's more the former, but that's, again, anecdotal. My university has both types of program but we rarely interact because counseling psych is in the department of education--however, the folks I do know from that program seem to pretty strongly fall into this camp. My sense is that counseling psychology is probably more variable on this front. @The Cinnabon might have some input.

 

[MCParent]

When I was faculty in a CounPsy program we had pracs in integrated behavioral health at the hospital. My own students nearly all went to hospital/med school jobs (or other neat stuff like professional sport psych). We had req courses in EBTs and put in effort to counter fringey stuff that might come up in pracs. I taught EBTs. We were in a dept of ed.

But I dunno, I do think that there is variation with some CounPsy programs being happy to push out people mostly suited to worried-well PP or uni counseling centers with low acuity scope of practice. I was never at one of those.

Do bear in mind that it’s not like ClinPsych degrees are universally EBT-based. It’s just that those programs are pretty eager to self-label as not caring about research…

 

[MCParent]

Be more active in finding the opportunities that you want and check the boxes for the mandatory stuff.

This is the way.

I used to get annoyed with students when they would (not commonly but sometimes) say “my stats prof didn’t teach what Cronbach’s alpha was clearly so I don’t know what it is” or “the prof didn’t use enough examples to cover how to do motivational interviewing so I can’t do it” or whatever. There are 100 YouTube videos and dozens of books explaining everything we cover in grad school. Sometimes you have to watch/read/listen to/whatever them.

 

[The Cinnabon]

I am in a clinical program, not counseling, but my anecdotal experience with counseling psychology students has been a mixed bag between strong dedication to EBP and knowledge about the limitations of common factors research and the wholesale adoption of the belief that literally everything is common factors. I personally feel it's more the former, but that's, again, anecdotal. My university has both types of programs but we rarely interact because counseling psych is in the department of education--however, the folks I do know from that program seem to pretty strongly fall into this camp. My sense is that counseling psychology is probably more variable on this front. @The Cinnabon might have some input.

Pretty mixed in my program and I suspect there's some level of self selection. The experiences are there to gain pretty in depth exposure to EBPs, but there are experiences that may also orient you to a college counseling career where Wampold and Yalom are hailed as supreme above all else ... you can also pretty easily tell which faculty at our program falls into which camp too

Everyone is required to take courses with experimental and clinical students, whose instructors take great pleasure in ripping apart popular modalities/interventions that Counesling students are probably more likely to utilize/follow.

From a practice perspective we start psychotherapy before assessment and the clinical program is vice versa. I often wish we adopted the clinical program's training sequence as they tend to have a much firmer understanding of psychopathology and diagnosis prior to preforming treatment themselves.

Having said all of that, all roads lead to Rome and prac is where you learn the majority of whatever clinical paradigm. Our in-house clinic director is firmly CBT oriented and expects our conceptualizations/treatment plans to be rooted in the literature.

 

[R. Matey]

I am also a counseling psychologist whose interests in counseling psychology lie primarily in the psychometric (personality) tradition of vocational psychology (love a Strong; where are my E.G. Williamson fans at?). To anyone who has been around a counseling psychology program, in oh, the last 50 years or so, it will probably come as no surprise that my perspective was... ahem...unpopular. But one good thing my advisor did for me repeatedly hammer into my head was that a Ph.D. is a self-directed exercise and that it was up to me to choose what I wanted for my degree and my career. How that shook out is that I pursued my interests in stats in extra coursework, which eventually led me to my AMC postdoc and the job that I have now (which is mostly clinical tbh, but I was able to trade on stats for content knowledge in a clinical area).

Clinically, I have similar experiences in counseling psychology than what is being described. Relation-cultural with something something attachment theory was everyone's favorite buzzwords. I was the weird one reading Paul Salovskis, Aaron Beck, Christine Padesky, Robert Leahy, and David Clark. I wasn't alone though. My friends who fell into peds, health, sports, and forensics were more open to EBPs than those who favored a UCC or PP trajectory though I wouldn't necessarily paint that group with a broad brush either. I was alone and miserable on my UCC internship that was a backup for me to which I went kicking-and-screaming into, but that's another story.

What I did like about counseling psychology is the emphasis on what Donald Super called hygiology or what we've come to call contextual factors. In my counseling psychology coursework, I had exceptionally good training in how to help people struggling with career transitions, talk openly about people's identities, had direct supervised experience on how to conduct supervision and consultation, and, yes, how to administer evidence-based practices (though this was less emphasized than I would've liked). As someone who checks many of the privilege boxes, this was an important exercise in empathy, humility, and caring for others (even though it wasn't always framed that way by teachers).

Having now worked with clinical psychologists across the training spectrum (us counseling psychs are typically scientist-practitioner compared with much more variation in clinical psychology), I can see how the emphasis on contextual factors adds to a training experience. Similar to you, OP, my clinical science colleagues in the past have told me they wished their program emphasized gender and race more than they did considering how these can show up clinically. I think in that case, the advice would be the same to them as it is to you: self-study is key 🙂

 

[cara susanna]

Pretty mixed in my program and I suspect there's some level of self selection. The experiences are there to gain pretty in depth exposure to EBPs, but there are experiences that may also orient you to a college counseling career where Wampold and Yalom are hailed as supreme above all else ... you can also pretty easily tell which faculty at our program falls into which camp too

Everyone is required to take courses with experimental and clinical students, whose instructors take great pleasure in ripping apart popular modalities/interventions that Counesling students are probably more likely to utilize/follow.

From a practice perspective we start psychotherapy before assessment and the clinical program is vice versa. I often wish we adopted the clinical program's training sequence as they tend to have a much firmer understanding of psychopathology and diagnosis prior to preforming treatment themselves.

Having said all of that, all roads lead to Rome and prac is where you learn the majority of whatever clinical paradigm. Our in-house clinic director is firmly CBT oriented and expects our conceptualizations/treatment plans to be rooted in the literature.

I'm pretty sure (that is, if I remember correctly), you attend the counseling program at the same school where I attended the clinical program. It'd be interesting to compare our experiences. Assessment definitely seems to be a strength of the clinical program, based on feedback I've gotten from supervisors and colleagues as a practicing clinician.

 

[The Cinnabon]

I'm pretty sure (that is, if I remember correctly), you attend the counseling program at the same school where I attended the clinical program. It'd be interesting to compare our experiences. Assessment definitely seems to be a strength of the clinical program, based on feedback I've gotten from supervisors and colleagues as a practicing clinician.

I am! My perception is that the clinical program gets pretty phenomenal assessment training, it also seems ubiquitous. In comparison, at the counseling program you need to be much more intentional about seeking quality assessment experience.

 

[Zazulator]

Hi there! I completed my PhD in counseling psych and recall feeling similar to you at points in my training. I ended up seeking out pre-doc internship sites that would give me EBP training and found that my strong grounding in the common factors really aided me in making the EBPs my own and not coming across as rigid or inauthentic. EBPs can be easily learned and prioritized for internship and post-doc, so I would not worry too much about it and if you really want to try your hand at some EBPs, you could read up on them and see if you can get an appropriate client in your training clinic for whatever EBP you want to work on. For what it's worth, when I got to internship with interns from a wide variety of programs, no one had much formal EBP experience at all, so don't sweat it!

I will say - my program had a very strong assessment focus, which I am grateful for. I wonder if there are any opportunities to grow your assessment experience that faculty could point you towards? If not, this could be another area for training on pre-doc internship.

 

[R. Matey]

I will say - my program had a very strong assessment focus, which I am grateful for. I wonder if there are any opportunities to grow your assessment experience that faculty could point you towards? If not, this could be another area for training on pre-doc internship.

I also got great assessment training in graduate school, but I did have to be intentional about seeking it out.

 

[Justanothergrad]

Hi all

I'm an advanced student in a Counseling Psychology program in the south (not specifying more for anonymity purposes), and yeah, I have some pretty serious issues with Counseling Psychology and have been doubting my training. I will also be the first to admit that this may just be my program and is not indicative of the field as a whole.

Anyways, my core issue throughout my training has been the extreme emphasis on common factors based training with my exposure to assessment and EBPs pretty lackluster compared to my clinical colleagues. I really do feel as though it can, at times, feel like non-directive supportive therapy is what faculty/supervisors were looking for or prioritizing in what they wanted to see in us clinically. I feel like a total black sheep in my program and can't but help wonder if I should have stuck to solely applying to clinical PhDs or if this is more of a program issue? I'm wondering if anyone else has ever felt this way and know that this can be a touchy subject?

I mean, we do it badly some but im not convinced of the est lit, as someone who votes on their approval for d12. They likely arent good at explaining how all specific mechanisms are the same. Which is what allows est arguments. I was also trained by a major author of those est d17 guidelines etc

Still. There are reasons to distrust est logic.

People say we dont do assessment in cou. I do more than most in any field. Its bias and choice, and stereotypes. My students dont hear that bs. Ever. Anyway, join assessment communities- they advise better than others about planning. Most people are assessment clueless

 

[DoubtfulDoc]

I mean, we do it badly some but im not convinced of the est lit, as someone who votes on their approval for d12. They likely arent good at explaining how all specific mechanisms are the same. Which is what allows est arguments. I was also trained by a major author of those est d17 guidelines etc

Still. There are reasons to distrust est logic.

People say we dont do assessment in cou. I do more than most in any field. Its bias and choice, and stereotypes. My students dont hear that bs. Ever. Anyway, join assessment communities- they advise better than others about planning. Most people are assessment clueless

Agreed, counselor here. I do more assessments than the clinical and counseling-trained folks at my hospital. It’s a choice and interest I was able to pursue, thankfully. I read a lot, ask a lot of questions, attend CEs about assessment often, and try to participate in assessment-related research as much as I can.

I echo the sentiment about common factors and putative mechanisms of change in therapy. Kazdin has written some nice articles about how little we actually know about what makes therapy successful and how challenging it can be to figure this out.

DIV12 gets some things right, but misses the mark on others. The updated criteria (Tolin and McKay) are a step in the right direction, but will still fall short of explaining the mechanisms of change at play. I think with all the evidence that many therapies for several conditions like depression, for example, have equivalent outcomes (see Cuijpers’s work) and Bergen & Garfield discuss in their most recent handbook, means the EST base as it stands presently has hit a wall. I know Tolin and Hupp have just tried to revise the effort at identifying or elaborating on underlying mechanisms of change. I hope this is fruitful.

 

[Therapist4Chnge]

Yeah science and data are great and whatever, but maybe I can introduce you to this NEW therapy that everyone is talking about….Brainspotting. Sure, if you like *air quotes* “empirically validated” treatments, then it’s not for you. But, if you are special, and I mean REALLY SPECIAL, then you could be ready for Brainspotting. Only if you Reiki expert and astrologer sign off on it though bc it can be TOO powerful otherwise. Misaligned chakras can really upset a person’s Extra Complex ADHD, so be careful.

 

[Justanothergrad]

Agreed, counselor here. I do more assessments than the clinical and counseling-trained folks at my hospital. It’s a choice and interest I was able to pursue, thankfully. I read a lot, ask a lot of questions, attend CEs about assessment often, and try to participate in assessment-related research as much as I can.

I echo the sentiment about common factors and putative mechanisms of change in therapy. Kazdin has written some nice articles about how little we actually know about what makes therapy successful and how challenging it can be to figure this out.

DIV12 gets some things right, but misses the mark on others. The updated criteria (Tolin and McKay) are a step in the right direction, but will still fall short of explaining the mechanisms of change at play. I think with all the evidence that many therapies for several conditions like depression, for example, have equivalent outcomes (see Cuijpers’s work) and Bergen & Garfield discuss in their most recent handbook, means the EST base as it stands presently has hit a wall. I know Tolin and Hupp have just tried to revise the effort at identifying or elaborating on underlying mechanisms of change. I hope this is fruitful.

Many (most?) of Cuijpers' articles should be required reading of all students. An absolute fantastic scholar.

 

[DoubtfulDoc]

Many (most?) of Cuijpers' articles should be required reading of all students. An absolute fantastic scholar.

100% agree! @Justanothergrad. I’m at a small VA in the Midwest trying to drum up my own program of research and get others to do research too and feel like I’m hitting a wall when I try to talk about assessment and outcome literature. My talk of Cuijpers and his monumental work just falls on deaf ears unfortunately. I mean he made his metapsy project available to the public! But the majority do the folks I work with will sadly never understand or appreciate it.

 

[DoubtfulDoc]

100% agree! @Justanothergrad. I’m at a small VA in the Midwest trying to drum up my own program of research and get others to do research too and feel like I’m hitting a wall when I try to talk about assessment and outcome literature. My talk of Cuijpers and his monumental work just falls on deaf ears unfortunately. I mean he made his metapsy project available to the public! But the majority do the folks I work with will sadly never understand or appreciate it.

@Justanothergrad you know the Bergin & Garfield handbook? Same thing…I feel like it should be required reading but so few don’t get exposed to it in grad school.

 

[R. Matey]

Yeah science and data are great and whatever, but maybe I can introduce you to this NEW therapy that everyone is talking about….Brainspotting. Sure, if you like *air quotes* “empirically validated” treatments, then it’s not for you. But, if you are special, and I mean REALLY SPECIAL, then you could be ready for Brainspotting. Only if you Reiki expert and astrologer sign off on it though bc it can be TOO powerful otherwise. Misaligned chakras can really upset a person’s Extra Complex ADHD, so be careful.

You see, it's all about the relationship with your therapist while you're brainspotting /s

 

[WisNeuro]

You see, it's all about the relationship with your therapist while you're brainspotting /s

Yeah, I love the contradiction and lack of insight from these people who misunderstand and state "common factors" are the only thing that matters, but will then spend thousands of dollars on pseudoscience training and make that their hill to die on.

 

[R. Matey]

Yeah, I love the contradiction and lack of insight from these people who misunderstand and state "common factors" are the only thing that matters, but will then spend thousands of dollars on pseudoscience training and make that their hill to die on.

IME, these folks tend to have poor science and procedural training so they latch on to concepts that enable them to practice in a manner feels right to them. And there’s obviously a market for it.

 

[Therapist4Chnge]

IME, these folks tend to have poor science and procedural training so they latch on to concepts that enable them to practice in a manner feels right to them. And there’s obviously a market for it.

I think this is usually pretty accurate. I have run into a couple of brainspotting "experts" over the past few years and asked them about the neurophysiology of brainspotting and you can guess how that went. I even told them to not be afraid to "get technical" because I had a strong background in neuroanatomy and neurophysiology. It was always word salad and very cringy.

For those curious, here is a quick article about it being pseudoscience. Brainspotting Is Pseudoscience

 

[Justanothergrad]

@Justanothergrad you know the Bergin & Garfield handbook? Same thing…I feel like it should be required reading but so few don’t get exposed to it in grad school.

Yeh i usually require it, or have, for the same reason. Im moving more towards articles only now but thats just a fad for me to change it up and match other courses.

 

[MCParent]

I think this is usually pretty accurate. I have run into a couple of brainspotting "experts" over the past few years and asked them about the neurophysiology of brainspotting and you can guess how that went. I even told them to not be afraid to "get technical" because I had a strong background in neuroanatomy and neurophysiology. It was always word salad and very cringy.

For those curious, here is a quick article about it being pseudoscience. Brainspotting Is Pseudoscience

I’ll never get over the emdr national level trainer who told me that the eye movements “unclog your brain’s pipes.”

 

[Justanothergrad]

I’ll never get over the emdr national level trainer who told me that the eye movements “unclog your brain’s pipes.”

Once the brain pipes are unclogged, thought juice flows better in the idea box.

 

[MCParent]

Once the brain pipes are unclogged, thought juice flows better in the idea box.

The alarming thing was that it was NOT intended to be a metaphor…

 

[AcronymAllergy]

The alarming thing was that it was NOT intended to be a metaphor…

You mean the brain isn't just a series of pipes, cogs, levers, and steam release valves? I call shenanigans. Next thing you know, you'll be telling me that we don't only use 10% of our brain.

 

[WisNeuro]

"It's not a big truck. It's a series of tubes. And if you don't understand, those tubes can be filled and if they are filled, when you put your message in, it gets in line and it's going to be delayed by anyone that puts into that tube enormous amounts of material, enormous amounts of material."

 

[Sanman]

Once the brain pipes are unclogged, thought juice flows better in the idea box.

I hear drano helps with that. I usually add a few drops to my daily bleach cocktail before bathing my insides with sunlight.

 

[RxPsych]

You mean the brain isn't just a series of pipes, cogs, levers, and steam release valves? I call shenanigans. Next thing you know, you'll be telling me that we don't only use 10% of our brain.

The cartoons were right all along!

 

[cara susanna]

The therapist sub LOVES the Dodo Bird Hypothesis and I have to keep explaining that, when you look at specific diagnoses, the effect is less evident

 

[WisNeuro]

The therapist sub LOVES the Dodo Bird Hypothesis and I have to keep explaining that, when you look at specific diagnoses, the effect is less evident

But, I'd rather collapse a bunch of heterogeneous things into one somewhat arbitrary group so that we lose any actual significant findings! That way, my hypothesis is supported through shoddy methodology!

 

[Sanman]

The therapist sub LOVES the Dodo Bird Hypothesis and I have to keep explaining that, when you look at specific diagnoses, the effect is less evident

But what about EMDR?! It's better than everything else!

 

[WisNeuro]

But what about EMDR?! It's better than everything else!

It cured my cancer and works better than Viagra! Now I'm hoping it can reverse the effects of vaccination!

 

[Therapist4Chnge]

Too late, your dog and house plants now have autism!! Their 5G signals are istronger than ever at least.

 

[cara susanna]

At least it's not dog autism!

 

[Justanothergrad]

The therapist sub LOVES the Dodo Bird Hypothesis and I have to keep explaining that, when you look at specific diagnoses, the effect is less evident

Though I'd argue the specific mechanisms have almost no causal evidence (see impact statement and other dismantling studies/order effect studies) and still appear to account for less explained variance, particularly given a lack of studies controlling it despite a longstanding history of clear moderation.

 

[R. Matey]

Though I'd argue the specific mechanisms have almost no causal evidence (see impact statement and other dismantling studies/order effect studies) and still appear to account for less explained variance, particularly given a lack of studies controlling it despite a longstanding history of clear moderation.

In terms of statistical rigor, both areas (common factors and ESTs) are in need of improvement, but the current clinical guidance still supports CBT as first line treatment. Even your boy Pim Cuijpers seems to take this position.

 

[Justanothergrad]

In terms of statistical rigor, both areas (common factors and ESTs) are in need of improvement, but the current clinical guidance still supports CBT as first line treatment. Even your boy Pim Cuijpers seems to take this position.

Yeh, im not convinced that guidance is good, frankly. Tons of improvement needed but i dont see people taking opportunities even when they have thr data. The shortcoming of the guidance comes from its methods, but also its legal defensiveness as a result. If I claim a mechanism, I do not have to show it, which precludes evidence of it (eg cognition versus awareness). And leads to major legal challenges to justify them (haven been part of those discussions). The key part of Pim's positioning rest in the term "a first line treatment" as opposed to "the front line treatment", which is more supported relative efficacy which we dont see. His work is clear in its finding of against a singular "gold standard" or whatever similar terms.

 

[R. Matey]

Yeh, im not convinced that guidance is good, frankly. Tons of improvement needed but i dont see people taking opportunities even when they have thr data. The shortcoming of the guidance comes from its methods, but also its legal defensiveness as a result. If I claim a mechanism, I do not have to show it, which precludes evidence of it (eg cognition versus awareness). And leads to major legal challenges to justify them (haven been part of those discussions). The key part of Pim's positioning rest in the term "a first line treatment" as opposed to "the front line treatment", which is more supported relative efficacy which we dont see. His work is clear in its finding of against a singular "gold standard" or whatever similar terms.

I get where you're coming from, but I don't think that belies CBT's position as a first/front-line treatment. Sure, there are mechanistic limits to the research, but that is true for literally every idea in psychotherapy as well as many in psychiatric medications. Should we not issue clinical guidance until we have absolute mechanistic certainty? We have enough evidence from clinical experience, case studies, and RCTs to know that it works or can be modified for many physical and mental health problems to a degree that allows us to have probabilistic confidence in the treatment. Does it work for absolutely everyone? No, I don't even think David Tolin would claim that. My experience as a clinician is that CBT fails usually due to problems with patient feasibility (they don't want to do it due to misinformation, low motivation, etc), but I remain open to the idea that something sometime may surpass CBT as a front/first-line treatment with greater efficacy. I think the emphasis on EMAs using DSEM has been a really promising development in the psychopathology field as of late. One that I'm watching with interest.

ETA: Regarding legal stuff, I imagine that issuing guidelines actually protects clinicians given that it sets up a community standard from which they can practice.

 

[The Cinnabon]

I get where you're coming from, but I don't think that belies CBT's position as a first/front-line treatment. Sure, there are mechanistic limits to the research, but that is true for literally every idea in psychotherapy as well as many in psychiatric medications. Should we not issue clinical guidance until we have absolute mechanistic certainty? We have enough evidence from clinical experience, case studies, and RCTs to know that it works or can be modified for many physical and mental health problems to a degree that allows us to have probabilistic confidence in the treatment. Does it work for absolutely everyone? No, I don't even think David Tolin would claim that. My experience as a clinician is that CBT fails usually due to problems with patient feasibility (they don't want to do it due to misinformation, low motivation, etc), but I remain open to the idea that something sometime may surpass CBT as a front/first-line treatment with greater efficacy. I think the emphasis on EMAs using DSEM has been a really promising development in the psychopathology field as of late. One that I'm watching with interest.

ETA: Regarding legal stuff, I imagine that issuing guidelines actually protects clinicians given that it sets up a community standard from which they can practice.

A particularly salient quote I recall from Doing CBT was Tolin stating they would immediately invest in a leech farm if massive swaths of evidence suddenly suggested that bloodletting was the bees knees of mental health treatmentts. Ultimately that's what attracts me as a much newer trainee, while there are strong limitations in exact mechanisms of action ... CBT ultimately seems to be the most practical choice and the theory that is most rooted in empiricism as a central tenant. My anecdotal experiences with your average CBT practitioners I've ran accross has generally been that they would happily discontinue usage of CBT in their practice if something new came along with more promising, well-understood, and robustness in evidence. I can't say the same about practioners I've interacted with who strongly align with other theoretical orientations where it seems to be described as more of an emotional "click" so to speak.